engleski

SORIN FREEDOM SOLO STENTLESS VALVE IN SURGICAL THERAPY OF AORTIC VALVE ENDOCARDITIS: INITIAL RESULTS AND MID-TERM FOLLOW UP

Background: Despite significant improvement in antibiotic therapy, aortic valve endocarditis, with or without perivalvular abscess, still represents significant surgical challenge. Homograft implantation is the gold standard of surgical therapy, but new artificial valves attract more attention due to easier availability. We present our results in utilizing the Sorin Freedom SOLO stentless aortic valve in surgical management of aortic valve endocarditis. Methods: From January 2009 until January 2013, seventeen male patients underwent aortic valve replacement due to aortic valve endocarditis utilizing the Sorin Freedom SOLO bioprosthesis made of bovine pericardium. Follow-up and postoperative echo data were collected in a prospective manner. Results: There were 9 emergent surgeries (56%), 5 urgent (31%), and 2 elective (13%). Average age was 61.5±8.74 years (range 43–76) with median EuroSCORE 10, and logistic EuroSCORE mortality 23.09±20.09% (4.4–59.7%). One patient underwent concomitant mitral valve replacement, and four patients had annular abscesses which were closed with glutaraldehyde treated autologous pericardium. Average aortic cross-clamp time for isolated aortic valve replacement was 58.81±19.25 minutes (42–98), and for combined procedures (mitral valve replacement, closure of subannular abscess) 112.8±22.6 minutes (82–141). Median valve size was 25mm (23–27). Follow up was 18.98±14.49 months (0.1–43.86). Two patients died during hospital stay due to multi-organ failure, and one died during mid-term follow-up, for an overall mortality of 18%. Early mean postoperative transvalvular gradient was 11.22±4.36 mmHg(7– 15.8), and medium-term gradient was 12.5±5.6 mmHg. During follow-up, there were neither structural valve deterioration of any kind nor prosthetic valve endocarditis. Conclusion: Because of its specific implantation technique with single supra- annular suture line, and absence of any artificial material in its design, Sorin Freedom SOLO stentless bioprosthesis is a valuable tool in surgical management of aortic valve endocarditis. Although our initial results are encouraging, further follow-up is necessary.

surgical therapy ; endocarditis

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